Inspection on 14/12/05 for Treetops

This inspection was carried out on 14th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Treetops 19/07/07

Treetops 07/07/06

Treetops 29/06/05

Treetops 01/02/05

Treetops 19/07/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Treetops St Clements Road Keynsham Bath & N E Somerset BS31 1AF Lead Inspector Andrew Pollard Unannounced Inspection 14th December 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Treetops Address St Clements Road Keynsham Bath & N E Somerset BS31 1AF Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0117 9869700 0117 9860063 treetops@shaw-carehomes.co.uk Shaw healthcare Limited Mrs Teresa Eileen Handford Care Home 24 Category(ies) of Dementia (24), Dementia - over 65 years of age registration, with number (24), Mental disorder, excluding learning of places disability or dementia (24), Mental Disorder, excluding learning disability or dementia - over 65 years of age (24) Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Manager must be a RN on parts 3 or 13 of the NMC register Staffing Notice dated 23/04/1999 applies The total number of people who may be accommodated in the home at any one time shall not exceed 24. The home may not admit any service users with a definitive diagnosis of mental disorder (which is their primary care need) until the qualified staffing skill issues have been satisfactorily addressed and agreed by the NCSC. The home may accommodate people aged 55 years and over. 5. Date of last inspection 29th June 2005 Brief Description of the Service: Treetops is registered as a Care Home for a maximum of 24 residents with dementia and or mental disorder requiring nursing care. The Home is situated in the grounds of Keynsham hospital, which easy access to local community facilities and is within easy access to Bristol and Bath. It can be accessed by car or by bus with a short walk. The Home is purpose built, providing a mix of single and en-suite rooms. Care is offered on the ground floor only, which is divided into 3 units. Each unit offers bedrooms, lounge-dining room and bathroom facilities. There is a communal common room and open plan smoking area. There are also pleasant gardens to the rear and side of the property. All parts of the home are accessible to wheelchair users as well as the ablebodied. Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The following methods of evidence gathering has been used in the production of this report; observation, discussion with residents and staff, relative and residents a tour of the home and sampling policies, records, care plans and viewing meals. Treetops is a well run home offering a good standard of care. The residents were happy, settled and secure which was evident from observations and conversations during the inspection. A very limited number of residents are able to engage in conversation due to advanced dementia. The manager has recently moved to a new job, which has caused a degree of unease amongst the staff, however interviews are arranged for the first week in January to appoint a new manager. An experienced nursing home manager from within the organisation is supporting the deputy manager at present. What the service does well: What has improved since the last inspection? A new British National Formulary has been acquired. Staff training is up to date. The relative/resident forum has been reinstated. Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Prospective clients and their families are given relevant information in written or verbal form about the home. The assessment process is rigorous and detailed. Introductory visits are arranged for prospective clients. Contracts and terms and conditions of services are provided to all clients. EVIDENCE: The statement of purpose (SOP) and service user guide SUG documents meet the regulatory requirements are comprehensive and written in plain English. Minor amendments have been made a full review will be undertaken by the new manager in due course. The home caters for older people with continuing social, mental health and physical health care and nursing needs. The majority of the current residents have organic dementias. Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 9 The 24 beds at Treetops are contracted via the PCT and placements co-ordinated by Dr N Moore and Dr Jelie consultant psycho geriatricians who manage all referrals. Admissions are taken on a priority of needs basis. When a vacancy arises Dr More liaises with the manager who then visits prospective residents prior to admission to assess their needs. Local authority funded residents also have a care management assessment and care plan form completed and available to the home prior to admission. The inspector reviewed the last admission to the home; which had completed pre-admission assessment material. Assessments are based around the activities of living. The manager has refused admissions that it was felt did not meet the admission criteria or the skill mix of the staff was not sufficient to manage the care. The previous inspection found that the staff had a range of skills and training relevant to the needs of the current resident group. The home sends a letter confirming the home’s ability to meet the needs to prospective residents or their representative. Placement reviews are regularly carried out that confirm that needs are being met. Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, The staff provide appropriate personal and nursing care to maintains residents health and well being. Proper arrangements are in place for residents to access primary healthcare services. The staff properly manages and administers medication. Detailed care plans are written. The homes philosophy promotes resident’s individuality, self-direction and empowerment. Risk are properly identified and managed EVIDENCE: All residents can remain registered with their own GP if they wish, however at present all are registered at the local St Augustine’s practice. Dr Blackwell visit the home every two weeks or upon request. The consultant psycho geriatrician also visits Treetops. A multidisciplinary meeting including Dr’s Moore, Dr Jelie and the GP, nursing staff, social workers and relatives are held quarterly to review residents care and well being and is available for advice and support. Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 11 Arrangements are made when requested for people to attend a local dentist or optician. Domiciliary optical services and dental reviews are provided on request for those who are unable to access the community facilities. All other specialist services are by GP referral if there is an assessed need. A person centred approach is used in the home. A 14-day observation period after admission informs the care plan development. The Care plan documentation, assessments and evaluations are based on the Activities of Daily Living. Individual files, were holistic and prescriptive of care. Where possible residents and families are involved with this process. Three case files were reviewed and they were found to be comprehensive and detailed. There was evidence of evaluation and updating, however some of the assessments had not been repeated in detail, which should be done annually and just repeated signatures and dates were entered. Mental state assessments and antecedence, behaviour and consequences records are made. Daily reports from the registered nurse in charge are written. There are individual risk assessments for moving and handling, pressure sore development falls and nutritional risk that are regularly reviewed and updated. There was little recorded evidence of resident consultation / involvement. This is due to the advanced dementias of the residents. The resident’s ability to exercise choice or make decisions is grossly diminished by cognitive impairment. Staff or relatives advocate on their behalf. Privacy and dignity issues are discussed during induction. Staff were observed to be knocking on doors before entering resident rooms. Resident and staff interactions were courteous and friendly. The home uses an individual blister pack dispensing administration system and nursing staff have responsibility for its management. No residents are safe or able to self-medicate. The resident’s drug profiles are part of the case file. The receipt, administration and CD records were up to date and in order. Temazepam is stored in a CD cupboard as required. The GP endorses changes to the MAR. There are no disposal records being made and the storage arrangements for drugs awaiting disposal is not secure. Temperature recordings for the drug’s fridge are monitored and recorded daily. The old BNF has been replaced with a current edition. A number of residents require limited restraint for their own protection from falls. Consent to restrictions such as bed rails, lap straps and Quantic chairs are formally recorded and kept under review. OT and the nursing team assess use of theses item. None of the residents are safe to go out of the home without escort. Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12;13,15 Residents have opportunities to take part in a range of leisure activities. The recreational and occupational arrangements in the home are varied. There is evidence of family inclusion and consultation where possible. The menus offer a varied and balanced diet. EVIDENCE: The activity organiser works full time and arranges a programme of recreational activities every week for each unit. There is also a programme of suggested activities for the unit staff to engage with as work allows. Events are displayed on notice boards. The records of resident participation in case files are limited. The home has access to mini bus transport owned by the organisation; a number of recent outings have taken place. Checks had been undertaken on staffs ability/legality to drive. The home has ‘thumbnail biographies” included in the care documentation for each person which gives relevant information about past history, social preferences etc and is utilised by staff in planning activities. Staff escort residents into the local high street to go to shops, cafés and other community facilities.. The local Cof E an RC clergy attends the home for pastoral visits and hold services; a number of residents also attend a local church. Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 13 A Christmas carol service will take place in the coming week and the staff are presenting a lighthearted nativity play. The home has an open visiting policy. Family and friends are welcome to visit. Visits can be made in people’s rooms or the conservatory areas. The relative/residents forums have been reinstated and there was a good attendance at the first meeting. Relatives are encouraged to participate in care reviews and care planning. A number of residents have regular contact with family members or friends including home visits, however in some cases residents have lost contact with family or do not wish to have contact. A Sherry and mince pie evening has been arranged to which family, friends had been invited. The staff have made a commendable effort to raise funds for each resident to be given a Christmas present. Local community entertainers attend the home on a weekly basis and include a Hawaiian dancer, musicians and singers. Residents or their families are encouraged wherever possible to manage their own finances. At present only one person manages his or her own pocket money. The residents spoken with who were able to express an opinion enjoyed their meals, and that the quantity was sufficient and they were happy in the home. The chef transferred from care to the chef position and having worked in a care position for several years had a good knowledge of resident likes and dislikes. The menus are a four-week rotation, which do not have formal choice. Residents are asked each morning if they would like an alternative, which is always provided upon request. Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 There are robust and comprehensive policies in place to prevent or manage complaints or allegations of abuse. There are good arrangements in place for staff training and awareness of POVA matters. EVIDENCE: The complaints policy and procedure contained all the required information and is available in the service user guide. There have been no complaints since the last inspection. Previous matters have been concluded and appropriate action taken. No allegations of abuse have been received. The home has the Local Authority “Protection of Vulnerable Adults (POVA) inter-agency reporting procedure”. The home had formulated written procedures for adult protection; whistle blowing, management of aggression, management of resident’s money/valuables. The majority of staff have undergone in house and NVQ based training in understanding and dealing with verbal and physical aggression, abuse and management of challenging behaviours including breakaway training. However at a recent meeting staff requested an update in these matters, which is being arranged. All staff have attended BANES, POVA training and further training is booked as required. Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 15 Resident’s allowances and valuable are held in the office safe; records of receipt and expenditure are maintained and two signatures are recorded for all transactions. Each person has his or her own wallet and ledger sheet. Only the manager, deputy and administrator have access to the safe keys. The accounts were subject to an external audit in March and an internal audit in November and all was found to be in order. Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,26 The home is fit for its purpose and suitable for the current resident group. Bedrooms suit the needs and tastes of the residents. The home is generally well furnished, maintained, clean, safe and comfortable. EVIDENCE: The home was purpose built to care for elderly people and has three individual units within the building Each individual unit provides one double bedroom, single bedrooms and a communal lounge/dining area, conservatory and access to the secure garden. The units are centred on the communal reception area, which accommodates an open plan area and enclosed common room. The home is at ground level, which ensures level access to all areas. Resident areas are fitted with appropriate aids such as grab rails, mobile and fixed hoists. The lounges and dining areas are well furnished and the décor is in good order. Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 17 Residents can chose to socialise in one of the more populated areas or have quiet time in their own room or one of the less used communal rooms. The redecoration and refurbishment programme are ongoing. The bedrooms were appropriately equipped and decorated. Those able to express an opinion liked their rooms and were able to personalise them as they wished. There are 3 shared bedrooms; people who share make a positive choice to do so and are made aware of this on admission if only a double room is available. All rooms have a telephone point from which residents can make and receive private calls. All rooms have a call system that is linked to an audible alarm facility. New Many rooms have adjustable Kings Fund beds. The home was in good general order, the standard of cleanliness was good and no mal odours were evident. An air purifier system has been installed in the three units. The kitchen was recently inspected by an EHO and found to be clean and in good order. Sluice areas included a sluicing disinfector on each unit. The laundry had two washing machines and two tumble dryers with appropriate programmes to ensure disinfection of foul linen. There are arrangements in place for the service and maintenance of plant and equipment. Maintenance staff are employed by the organisation. Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30 The home is adequately staffed with a combination of regular, bank staff that are appropriately trained and experienced. The recruitment procedures and records are in good order. Appropriate training arrangements are in place for care staff. EVIDENCE: The staffing levels were in accord issued by Avon Health Authority. Registered Mental Nurses are on duty for at least 3.24 whole time equivalent hours per week over day and night shifts. There are also first level general nurses employed whose skills are valuable for this resident group. There are no RN vacancies at present other than the manager post. Ms maybe the deputy manager is acting manager with regular support from Ms Bennett an experienced manger from a mental health nursing home in Wales. Interviews for the manager post are arranged for 6th January 06. Three vacancies for care staff have now been filled. There is minimal use of agency most extra duties being covered by bank staff and in general continuity of supply is maintained. There were sufficient ancillary and catering staff to meet the needs of the home. The home operates an equal opportunities employment policy. All staff are issued with written terms and conditions. The recruitment procedure is actioned and coordinated at Shaw Homes head office, including all recruitment paperwork, which remains stored at head Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 19 office, with copies available in the home. The files seen were in good order, other than copies of updated work permits for two recently appointed staff. The originals are at head office. The NMC validations of RN qualifications were up to date an in order. The NMC monthly up date of struck of Nurses was not available in the home. CRB checks had been completed through the personnel office for all staff. A log record of these checks is sent to the manager and was checked. All care staff have been issued with the GSCC code of practise. All new staff are enrolled on a formal induction programme, mentorship and the completion of an induction file. Care staff complete a foundation programme obtaining a ‘certificate in care practice’, so can then progress to the NVQ programme facilitated through Cirencester College. Mandatory training needs such as food hygiene, first aid, load handling, fire and health and safety were recorded for all staff. The RN clinical training records had been updated. The records seen previously indicated that in general RN’s are maintaining their learning in accord with PREP. Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 There are various methods and systems in place to monitor the quality of care and facilities. The management structure provides clear lines of accountability and support. The manager is well qualified and experienced for her post. The home has good Health and Safety and maintenance arrangements. EVIDENCE: Ms Bennett and Ms Maybe are Registered Mental Nurses they are accountable to the area manager and have regular supervision sessions and are well supported by the organisation. The resident forum is a vehicle for residents and more likely relatives to raise issues of concern or praise and discuss the manner in which the home operates. Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 21 Due to the impaired cognitive ability of the residents only limited information could be gained in discussion with them. Three residents were able to comment and felt well looked after and found the staff polite and caring. The food was said to be good. There were no complaints and in the general impression given was that the residents were happy and looked well kempt. A visitor spoken with was full of praise for the quality of the home and considered her father very happy. There is a quality audit based on the B&NES 10 components of good care. The most recent audit was conducted in Dec 04 and the collated results showed an overall high standard of attainment. The audit is due to be repeated in January. The home has been accredited with the ‘Investor in People’ award. Reference to management of resident’s finances is detailed in sections 16-18 above. Regulation 26 and 37 notices are submitted as required. The fire logbook, drills and training records were up to date and in order. Ms Carpenter has delegated responsibility for H&S matters and is the trainer for load handling. Regular H&S audits and environmental risk assessments are carried out to protect the residents from injuries. All residents have individualised risk assessments. Hot water outlet temperatures are monitored and recorded. The landlord’s gas safety certificate was in date. Load testing and hoist maintenance certificates were in order. Testing of portable electrical equipment had been carried out. Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 X 3 X 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP7 NU9 Regulation 14 & 15 13.2 Requirement Keep all assessments and care plans under review. Devise a secure method to store drugs awaiting disposal and make records of such. Timescale for action 31/12/05 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP12 OP15 OP29 Good Practice Recommendations Keep fuller records of resident participation in recreational activities. Offer a formal choice of main meals and keep records of such. Ensure copies of recruitment documentation are kept in the home. Contact the NMC to be on the mailing list for the monthly struck off or suspended staff list. Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Treetops DS0000020257.V270124.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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